Low profile periarticular tension band plating system with soft tissue neutralization cable tunnel/channel

ABSTRACT

A bone plating system comprising: a plate, where the plate is low-profile and capable of contouring to a bone; a variable number of screw holes, locking or non-locking; at least one channel or tunnel through the plate; and at least one flexible device passing through the channel or tunnel and passing through soft tissue attached to the bone. The low profile plate, in combination with the flexible device passing through the surrounding soft tissue, functions as a tension band and acts to neutralize the muscle forces tending to pull the bone apart at a fracture. The low profile tension band plating system is targeted for periarticular tensile fractures for repair of patella, olecranon, greater trochanter, greater tuberosity, radial styloid, lateral or medial malleoli, or lateral malleolus.

CROSS REFERENCE

Not Applicable.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates generally to a fracture plating system, and moreparticularly, but not by way of limitation, to a low profileperiarticular tension band plating system with soft tissueneutralization cable tunnel/channel.

2. Description of the Related Art

Small bone periarticular fractures, such as fractures around the kneeand elbow, can be problematic because of limited soft tissue coverageand the small size of bone fragments. Fracture plates currentlyavailable to treat these simple tensile fractures are bulky and areoften prominent, leading to a secondary surgery for hardware removal.Current plate systems require suitable bone quantity and quality and afracture pattern compatible with the device.

Additionally, a figure eight tension band wire is often used fortreatment of simple fractures around knee and elbow. Such wire isdifficult to place, remains prominent, and applies a variable andunknown amount of tension.

Another example of traditional cable fixation encircles the bone andinduces a variable but often large amount of soft tissue trauma,potentially devitalizing the surrounding bone.

Based on the foregoing, it is desirable to provide a low profilefracture plating system with cable fixation that can be passed easilyinto the surrounding soft tissues.

It is further desirable to provide such a system that is madespecifically for simple tensile fracture patterns and small bonefragments.

It is further desirable to provide such a system that functions as atension band.

It is further desirable to provide such a system that does not encirclethe bone, resulting in less soft tissue damage and therefore less bonedevitalization.

It is further desirable to provide such a system that allows thereduction clamp to stay in place during placement of the plating system.

SUMMARY OF THE INVENTION

In general, in a first aspect, the invention relates to a bone platingsystem comprising: a plate, where the plate is low-profile and capableof contouring to a bone; at least one channel or tunnel through theplate; and at least one flexible device passing through the channel ortunnel and passing through soft tissue attached to the bone. The atleast one flexible device may be capable of neutralizing tensile forces,and may not surround the bone, except occasionally when circumferentialwiring is used around the patella. The plate may be capable of beingcontoured to the bone in situ. The bone plating system may furthercomprise one or more holes in the plate and one or more screws attachingthe plate to the bone via the one or more holes. The one or more holesmay be threaded and the one or more screws may be locking screws,non-locking screws, or a combination thereof. The at least one flexibledevice may be a cable, suture, wire, elastic device, or combinationthereof. The soft tissue may be a tendon, ligament, or fascia.

When the bone is a patella with soft tissue extending upward from thepatella and downward from the patella or encircling the patella, theplate may be generally X-shaped such that the plate has two armsextending generally upward and two arms extending generally downward.The at least one channel or tunnel may pass through each of the two armsextending generally upward from the plate and each of the two armsextending generally downward from the plate. The flexible device maypass through the channel or tunnel in each of the two arms extendinggenerally upward and through the soft tissue extending upward from thepatella, and a second flexible device may pass through the channel ortunnel in each of the two arms extending generally downward and throughthe soft tissue extending downward from the patella. Alternately, theflexible device may pass through the channel or tunnel in each of thetwo arms extending generally upward, through the channel or tunnel ineach of the two arms extending generally downward, and through the softtissue extending upward and downward from the patella.

When the bone is an olecranon with soft tissue extending upward from theolecranon, the plate may generally have an elongated X shape, such thatthe plate has a center section, two arms extending generally upward, andtwo arms extending generally downward. The at least one channel ortunnel may pass through each of the two arms extending generally upwardfrom the plate. The flexible device may pass through the channel ortunnel in each of the two arms extending generally upward and throughthe soft tissue extending upward from the olecranon.

When the bone is a greater trochanter with soft tissue extending upwardfrom the greater trochanter, the plate may be generally Y-shaped, suchthat the plate has a downward-extending arm and two arms extendinggenerally upward. The at least one channel or tunnel may pass througheach of the two arms extending generally upward from the plate. Theflexible device may pass through the channel or tunnel in each of thetwo arms extending generally upward and through the soft tissueextending upward from the greater trochanter.

When the bone is a greater tuberosity with soft tissue extending upwardfrom the greater tuberosity, the plate may be generally T-shaped, suchthat the plate has a downward-extending arm and an upper portionextending anterior and posterior on the humerus. The at least onechannel or tunnel may pass through the upper portion of the plate. Theflexible device may pass through the channel or tunnel in the upperportion of the plate and through the soft tissue extending upward fromthe greater tuberosity.

When the bone is a radial styloid with soft tissue extending upward fromthe radial styloid, the plate may be generally Y-shaped, such that theplate has a downward-extending arm and two arms extending generallyupward. The at least one channel or tunnel may pass through each of thetwo arms extending generally upward from the plate. The flexible devicemay pass through the channel or tunnel in each of the two arms extendinggenerally upward and through the soft tissue extending upward from theradial styloid.

When the bone is a medial malleoli with soft tissue extending downwardfrom the medial malleoli, the plate may be generally shaped like anupside-down Y, such that the plate has an upward-extending arm and twoarms extending generally downward. The at least one channel or tunnelmay pass through each of the two arms extending generally downward fromthe plate. The flexible device may pass through the channel or tunnel ineach of the two arms extending generally downward and through the softtissue extending downward from the medial malleoli.

When the bone is a lateral malleolus with soft tissue extending downwardfrom the fibula, the plate may be generally shaped like an upside-downY, such that the plate has an upward-extending arm and two armsextending generally downward. The at least one channel or tunnel maypass through each of the two arms extending generally downward from theplate. The flexible device may pass through the channel or tunnel ineach of the two arms extending generally downward and through the softtissue extending downward from the fibula.

The bone plating system may be used according to the following method:clamping a broken bone; applying a plate to the bone, where the plate islow-profile and has at least one channel or tunnel therethrough; passinga flexible device through the at least one channel or tunnel and throughsoft tissue surrounding the bone; and unclamping the bone. The methodmay further comprise contouring the plate to the bone after applying theplate to the bone, and/or attaching the plate to the bone with one ormore screws prior to passing the flexible device through the at leastone channel or tunnel and through the soft tissue surrounding the bone.The at least one channel or tunnel may be at least one channel locatedadjacent to at least one hole through which the one or more screwsattaches the plate to the bone and the one or more screws may each havea screw head; if so, the method may further comprise tightening the oneor more screws after passing the flexible device through the at leastone channel and through the soft tissue surrounding the bone, such thatthe flexible device is located in the at least one channel underneaththe screw heads and the screw heads maintain the flexible device withinthe at least one channel. If the flexible device is wire, the method mayfurther comprise crimping the wire to secure the wire to the plate bypreventing the wire from unthreading from the at least one channel ortunnel. If the flexible device is a suture, the method may furthercomprise tying the suture to secure the suture to the plate bypreventing the suture from unthreading from the at least one channel ortunnel. If the flexible device is cable, the method may further comprisecrimping the cable to secure the cable to the plate by preventing thecable from unthreading from the at least one channel or tunnel. If theflexible device is an elastic polymer, the method may further comprisetying the elastic polymer to secure the elastic polymer to the plate bypreventing the elastic polymer from unthreading from the at least onechannel or tunnel.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a front view of the bone plating system of the presentinvention in place on a patella;

FIG. 2 is a side view of the bone plating system in place on a patella;

FIG. 3 is a perspective view of the plate of the bone plating system;

FIG. 4 is a front view of one embodiment of the plate of the boneplating system;

FIG. 5 is a side view of the embodiment of the plate shown in FIG. 4;

FIG. 6 is a front view of a second embodiment of the plate of the boneplating system;

FIG. 7 is a side view of the embodiment of the plate shown in FIG. 6;

FIG. 8 is a side view of the bone plating system in place on anolecranon;

FIG. 9 is a front view of the bone plating system in place on anolecranon;

FIG. 10 is a side view of the bone plating system in place on a greatertrochanter;

FIG. 11 is a front view of the bone plating system in place on a greatertrochanter;

FIG. 12 is a side view of the bone plating system in place on a greatertuberosity of a humerus;

FIG. 13 is a front view of the bone plating system in place on a greatertuberosity of a humerus;

FIG. 14 is a side view of the bone plating system in place on a radialstyloid;

FIG. 15 is a front view of the bone plating system in place on a radialstyloid;

FIG. 16 is a side view of the bone plating system in place on a medialmalleoli;

FIG. 17 is a front view of the bone plating system in place on a medialmalleoli;

FIG. 18 is a side view of the bone plating system in place on a lateralmalleolus of a fibula; and

FIG. 19 is a front view of the bone plating system in place on a lateralmalleolus of a fibula.

DETAILED DESCRIPTION OF THE INVENTION

The devices and methods discussed herein are merely illustrative ofspecific manners in which to make and use this invention and are not tobe interpreted as limiting in scope.

While the devices and methods have been described with a certain degreeof particularity, it is to be noted that many modifications may be madein the details of the construction and the arrangement of the devicesand components without departing from the spirit and scope of thisdisclosure. It is understood that the devices and methods are notlimited to the embodiments set forth herein for purposes ofexemplification.

In general, in a first aspect, the invention relates to a semi-rigidbone plate that functions as a tension band, combined with soft tissuecabling, suturing, or other flexible device to augment and extendfixation. The device is best used for the surgical repair of simpletensile fractures that occur with relative frequency in specificanatomical regions of the body with minimal soft tissue coverage. Inparticular, the low profile tension band plating system is targeted forperiarticular tensile fractures for repair of patella, olecranon,greater trochanter, greater tuberosity, radial styloid, lateral andmedial malleoli, or lateral malleolus.

As shown in FIGS. 1 through 19, the system is comprised of a plate 1,which may be low profile and malleable such that it can be easilycontoured to the surface of the bone 10. Such contouring may occur insitu. The plate 1 may have varying number of holes 2 for screw fixation,which may use locking or non-locking screws 5. The holes 2 may bethreaded, allowing for the optional use of locking screws 5 at thediscretion of the surgeon.

The plate 1 may have a channel or tunnel 3 at its proximal end, distalend, or both end. FIGS. 4 and 5 show a tunnel 3, while FIGS. 6 and 7show a channel 3. A cable, suture, wire, or other flexible device 4 mayrun through the channel or tunnel 3. The flexible device 4 may passthrough the soft tissue 11 surrounding the bone 10, such as a tendon,ligament, etc., and may secure to the plate 1. This extends fixation andneutralizes the forces of the muscles tending to pull the bone apart. Ifthe flexible device 4 is a wire, the ends of the wire may be clamped orcrimped to prevent the wire from unthreading from the channel or tunnel3. Alternately, one end of the wire may terminate in a bead, and theother end of the wire may be clamped or crimped. If the wire endsoverlap, they may be twisted together or crimped to hold the wire inplace. If the flexible device 4 is a suture, it may be tied to preventunthreading. If the channel or tunnel 3 is a channel, as shown in FIGS.6 and 7, the channel 3 may run adjacent to the holes 2, such that thehead of the screws 5 may cover the flexible device 4 and hold it inplace.

All elements may be made of any suitable material. For example, theplate may be surgical stainless steel or titanium. The flexible devicemay be metal, elastic polymer, or any other suitable material.

In use, the surgeon begins by reducing the broken bone 10, then applyingthe plate 1 to the bone 10. The surgeon may contour the plate 1 in situto allow the plate 1 to conform to the surface of the bone 10. Thesurgeon may then attach the plate 1 to the bone 10 with the screws 5, atleast partially. Next, the surgeon passes the flexible device 4 throughthe channels or tunnels 3 and through the soft tissue 11 surrounding thebone 10. The surgeon then secures the flexible device 4 relative to theplate 1. If the flexible device 4 is a wire, the surgeon may twist orcrimp one or both ends of the wire. If the flexible device 4 is asuture, the surgeon may tie off the suture. If the plate has channels 3adjacent the screws 5, the surgeon may then tighten the screws 5,locking the flexible device in place within the channel 3 below the headof the screw 5. Finally, the surgeon unclamps the bone 10. The shape ofthe plate 1, as described below, allows the plate 1 to be applied andsecured with the clamp in place on the bone 10.

When used on the patella, the plate 1 may be generally X-shaped, asshown in FIGS. 1 and 2. The plate 1 may be 2 mm to 2.4 mm thick. Asnoted above, the plate 1 may be malleable such that it conforms to theshape of the patella 12. The plate 1 may have holes 2 at the ends ofeach of its four arms, into which screws 5 may be placed to secure theplate 1 to the patella 12. Channels or tunnels 3 may be located at theend of each of the four arms of the plate 1, and flexible devices 4 mayrun through the channels or tunnels 3 and through the soft tissue 11surrounding the patella 12. The placement of the flexible devices 4allows for conversion of tensile force during movement into compressiveforce, holding the patella 12 together.

When used on the olecranon, the plate 1 may be generally long andnarrow, with two arms extending from its top and two from its bottom inan elongated X shape, as seen in FIGS. 8 and 9. The plate 1 may be 2 mmto 2.4 mm thick. As noted above, the plate 1 may be malleable such thatit conforms to the shape of the olecranon 13. A number of holes 2 may belocated in the arms for screw fixation to the olecranon 13. Channels ortunnels 3 may run through the arms extending from the top of the plate1, such that a flexible device 4 may pass through the channels ortunnels 3 and through the soft tissue 11 connected to and extendingupward from the end of the olecranon 13.

When used on the greater trochanter, the plate 1 may be generallyY-shaped, as shown in FIGS. 10 and 11. The plate 1 may be approximately2.7 to 3.5 mm thick. As noted above, the plate 1 may be malleable suchthat it conforms to the shape of the greater trochanter 14. Holes 2 maybe located in each of the three arms of the plate 1, allowing screws 5to attach the plate 1 to the greater trochanter 14. Channels or tunnels3 may be located through the upper arms of the plate 1, such that aflexible device 4 may pass through the channels or tunnels 3 and throughthe soft tissue 11 connected to and extending upward from the end of thegreater trochanter 14.

When used on the greater tuberosity, the plate 1 may be generallyT-shaped, as seen in FIGS. 12 and 13. The plate 1 may be 2.4 mm to 2.7mm thick. As noted above, the plate 1 may be malleable such that itconforms to the shape of the greater tuberosity 15. The plate 1 may haveholes 2 along its downward pointing portion and along its top lateralportion, allowing screws 5 to fix the plate 1 to the greater tuberosity15. Channels or tunnels 3 may be located in the top lateral portion ofplate 1, allowing a flexible device 4 to pass through the channels ortunnels 3 and through the soft tissue 11 connected to and extendingupward from the end of the greater tuberosity 15. The plate 1 may havethree channels or tunnels 3, such that three loops of flexible device 4pass through the soft tissue 11.

When used on the radial styloid, the plate 1 may be generally Y-shaped,as shown in FIGS. 14 and 15, with holes 2 located throughout the plate1, allowing screws 5 to fix the plate 1 to the radial styloid 16. Theplate 1 may be 2 mm thick. As noted above, the plate 1 may be malleablesuch that it conforms to the shape of the radial styloid 16. Channels ortunnels 3 may be located in the top branches of the plate 1, such that aflexible device 4 may pass therethrough and through the soft tissue 11attached to and extending from the radial styloid 16.

When used on the medial malleoli, as seen in FIGS. 16 and 17, the plate1 may be generally Y-shaped with holes 2 located throughout. Oriented onthe body, the Y-shaped plate 1 may be generally oriented downward, as anupside-down Y. The plate 1 may be 2 mm to 2.4 mm thick. As noted above,the plate 1 may be malleable such that it conforms to the shape of themedial malleoli 17. Screws 5 may attach the plate 1 to the medialmalleoli 17. Channels or tunnels 3 may be located in the downwardextending branches of the plate 1, such that flexible device 4 passingtherethrough may pass through the soft tissue 11 attached to andextending downward from the medial malleoli 17.

When used on the fibula, the plate may likewise be generally upside-downY-shaped, as seen in FIGS. 18 and 19. The plate 1 may be 2 mm to 2.4 mmthick. As noted above, the plate 1 may be malleable such that itconforms to the shape of the fibula 18. Holes 2 throughout the plate 1may allow the plate 1 to be attached to the fibula 18 via screws 5.Channels or tunnels 3 may be located in the downward extending branchesof plate 1, such that a flexible device may pass through the channels ortunnels 3 and through the soft tissue 11 attached to and extendingdownward from the fibula 18.

The plates 1 may be designed to function (biomechanically) purely astension bands. Because of the small size, low profile, and ductility ofthe plates 1, they may play a unique role in treating simpleperiarticular fractures that require both fracture compression andneutralization of soft tissue distracting forces. The cabling or suturecomponent 4 associated with these plates 1 extends surgical fixation ofthe implant construct by having an attached cable, suture, wire, orother flexible device 4 that is passed into the surrounding soft tissues11 and then secured to the plate 1. This technique may neutralizetensile deforming forces acting across the fixation construct.

The system is designed to augment and extend fixation. A cable wire,suture, or other flexible device 4 may pass through the surrounding softtissue 11 to extend fixation when small fragments or limited bone isavailable for screw fixation. The low profile design of plate 1 maybetter accommodate small bone fracture location due to limited softtissue coverage. The plate 1 may have a limited bone footprint thatdiminishes potential devascularization of the healthy bone. The lowprofile plate 1 may allow for easier placement without the removal ofthe reduction clamp. This is a significant benefit to the tension bandplating system.

The low profile plate 1 with flexible device 4 may be used in prominentbony areas with limited tissue coverage where current fracture platesare too bulky. This technique replaces the figure eight tension bandwire currently used, which is difficult to place, remains prominent, andapplies a variable and unknown amount of tension. The current plates 1are designed exclusively to function as a tension band and thereforeable to be much smaller and lower profile than traditional periarticularplating systems. Traditional plates are currently too bulky andcumbersome to implant. Traditional cable fixation encircles the bone andinduces a variable but often large amount of soft tissue trauma,potentially devitalizing the surrounding bone. The flexible device 4 ofthe present invention typically does not encircle the bone, whichresults in less soft tissue damage and therefore less bonedevitalization.

Whereas, the devices and methods have been described in relation to thedrawings and claims, it should be understood that other and furthermodifications, apart from those shown or suggested herein, may be madewithin the spirit and scope of this invention.

What is claimed is:
 1. A bone plating system comprising: a plate, wherethe plate is low-profile and capable of contouring to a bone; at leastone channel or tunnel through the plate; and at least one flexibledevice passing through the channel or tunnel and passing through softtissue attached to the bone.
 2. The bone plating system of claim 1 wherethe at least one flexible device is capable of neutralizing tensileforces.
 3. The bone plating system of claim 1 where the at least oneflexible device does not surround the bone.
 4. The bone plating systemof claim 1 where the plate is capable of being contoured to the bone insitu.
 5. The bone plating system of claim 1, further comprising one ormore holes in the plate and one or more screws attaching the plate tothe bone via the one or more holes.
 6. The bone plating system of claim5 where the one or more holes are threaded and the one or more screwsare locking screws, non-locking screws, or a combination thereof.
 7. Thebone plating system of claim 1 where the at least one flexible device isa cable, suture, wire, elastic polymer, or combination thereof.
 8. Thebone plating system of claim 1 where the soft tissue is a tendon,ligament, or fascia.
 9. The bone plating system of claim 1 where: thebone is a patella; soft tissue extends upward from the patella anddownward from the patella or encircles the patella; the plate isgenerally X-shaped, such that, the plate has two arms extendinggenerally upward and two arms extending generally downward; the at leastone channel or tunnel passes through each of the two arms extendinggenerally upward from the plate and each of the two arms extendinggenerally downward from the plate; the flexible device passes throughthe channel or tunnel in each of the two arms extending generally upwardand through the soft tissue extending upward from the patella; and asecond flexible device passes through the channel or tunnel in each ofthe two arms extending generally downward and through the soft tissueextending downward from the patella.
 10. The bone plating system ofclaim 1 where: the bone is a patella; soft tissue extends upward fromthe patella and downward from the patella; the plate is generallyX-shaped, such that the plate has two arms extending generally upwardand two arms extending generally downward; the at least one channel ortunnel passes through each of the two arms extending generally upwardfrom the plate and each of the two arms extending generally downwardfrom the plate; and the flexible device passes through the channel ortunnel in each of the two arms extending generally upward, through thechannel or tunnel in each of the two arms extending generally downward,and through the soft tissue extending upward and downward from thepatella.
 11. The bone plating system of claim 1 where: the bone is anolecranon; soft tissue extends upward from the olecranon; the plategenerally has an elongated X shape, such that the plate has a centersection, two arms extending generally upward, and two arms extendinggenerally downward; the at least one channel or tunnel passes througheach of the two arms extending generally upward from the plate; and theflexible device passes through the channel or tunnel in each of the twoarms extending generally upward and through the soft tissue extendingupward from the olecranon.
 12. The bone plating system of claim 1 where:the bone is a greater trochanter; soft tissue extends upward from thegreater trochanter; the plate is generally Y-shaped, such that the platehas a downward-extending arm and two arms extending generally upward;the at least one channel or tunnel passes through each of the two armsextending generally upward from the plate; and the flexible devicepasses through the channel or tunnel in each of the two arms extendinggenerally upward and through the soft tissue extending upward from thegreater trochanter.
 13. The bone plating system of claim 1 where: thebone is a greater tuberosity of a humerus; soft tissue extends upwardfrom the greater tuberosity; the plate is generally T-shaped, such thatthe plate has a downward-extending arm and an upper portion extendinganterior and posterior on the humerus; the at least one channel ortunnel passes through the upper portion of the plate; and the flexibledevice passes through the channel or tunnel in the upper portion of theplate and through the soft tissue extending upward from the greatertuberosity.
 14. The bone plating system of claim 1 where: the bone is aradial styloid; soft tissue extends upward from the radial styloid; theplate is generally Y-shaped, such that the plate has adownward-extending arm and two arms extending generally upward; the atleast one channel or tunnel passes through each of the two armsextending generally upward from the plate; and the flexible devicepasses through the channel or tunnel in each of the two arms extendinggenerally upward and through the soft tissue extending upward from theradial styloid.
 15. The bone plating system of claim 1 where: the boneis a medial malleoli; soft tissue extends downward from the medialmalleoli; the plate is generally shaped like an upside-down Y, such thatthe plate has an upward-extending arm and two arms extending generallydownward; the at least one channel or tunnel passes through each of thetwo arms extending generally downward from the plate; and the flexibledevice passes through the channel or tunnel in each of the two armsextending generally downward and through the soft tissue extendingdownward from the medial malleoli.
 16. The bone plating system of claim1 where: the bone is a lateral malleolus of a fibula; soft tissueextends downward from the fibula; the plate is generally shaped like anupside-down Y, such that the plate has an upward-extending arm and twoarms extending generally downward; the at least one channel or tunnelpasses through each of the two arms extending generally downward fromthe plate; and the flexible device passes through the channel or tunnelin each of the two arms extending generally downward and through thesoft tissue extending downward from the fibula.
 17. A method of boneplating, comprising: clamping a broken bone; applying a plate to thebone, where the plate is low-profile and has at least one channel ortunnel therethrough; passing a flexible device through the at least onechannel or tunnel and through soft tissue surrounding the bone; andunclamping the bone.
 18. The method of claim 17, further comprisingcontouring the plate to the bone after applying the plate to the bone.19. The method of claim 17, further comprising attaching the plate tothe bone with one or more screws prior to passing the flexible devicethrough the at least one channel or tunnel and through the soft tissuesurrounding the bone.
 20. The method of claim 19, where unclamping thebone occurs after attaching the plate to the bone and passing theflexible device through the at least one channel or tunnel and throughthe soft tissue surrounding the bone.
 21. The method of claim 19, wherethe at least one channel or tunnel is at least one channel locatedadjacent to at least one hole through which the one or more screwsattaches the plate to the bone and the one or more screws each have ascrew head, further comprising tightening the one or more screws afterpassing the flexible device through the at least one channel and throughthe soft tissue surrounding the bone, such that the flexible device islocated in the at least one channel underneath the screw heads and thescrew heads maintain the flexible device within the at least onechannel.
 22. The method of claim 17, where the flexible device is wire,further comprising crimping the wire to secure the wire to the plate bypreventing the wire from unthreading from the at least one channel ortunnel.
 23. The method of claim 17, where the flexible device is asuture, further comprising tying the suture to secure the suture to theplate by preventing the suture from unthreading from the at least onechannel or tunnel.
 24. The method of claim 17, where the flexible deviceis a cable, further comprising crimping the cable to secure the cable tothe plate by preventing the cable from unthreading from the at least onechannel or tunnel.
 25. The method of claim 17, where the flexible deviceis an elastic polymer, further comprising tying the elastic polymer tosecure the elastic polymer to the plate by preventing the elasticpolymer from unthreading from the at least one channel or tunnel.